Chapters authored
Videocapillaroscopy in Connective Tissue Diseases
Videocapillaroscopy is a noninvasive, quick, and easy examination method to indicate if there is clinical suspicion of microangiopathy. It provides the rheumatologist indispensable information on the microcirculation state. Recently with the development of the new classification criteria of systemic sclerosis (ACR 2013), capillaroscopy has become even more important. It is currently the only instrumental test whose result is pathognomonic for diagnosis of systemic sclerosis. During videocapillaroscopy, the following parameters are evaluated: density, structure, hemosiderin deposition, bloodstream, presence of megacapillaries, presence of subpapillary venous plexus, and edema. It can distinguish several patterns, especially scleroderma pattern, as follows: (1) “Early” pattern: few enlarged/giant capillaries, few capillary hemorrhages, relatively well‐preserved capillary distribution, no evident loss of capillaries; (2) “Active” pattern: frequent giant capillaries, frequent capillary hemorrhages, moderate loss of capillaries, mild disorganization of the capillary architecture, absent or mild ramified capillaries; (3) “Late” pattern: irregular enlargement of the capillaries, few or absent giant capillaries and hemorrhages, severe loss of capillaries with extensive avascular areas, disorganization of the normal capillary array, ramified/bushy capillaries. Although capillaroscopic examination is easy to perform, it is essential that the operator has been properly trained on the instrument’s function and on correct method of image acquisition to avoid misinterpretation.
Part of the book: Systemic Sclerosis
Rheumatic Diseases and Biosimilars: Evidence about Switch from Originators to Biosimilars in the Real Life
Biosimilars are broadly available for the treatment of several diseases including inflammatory arthritis. Thanks to biosimilars it has been possible to treat a greater number of rheumatic patients who previously were undertreated due to the high cost of originators, in several countries. There are a lot of data from double blind, randomized, controlled clinical trials, especially on TNF inhibitors (TNFi), concerning the maintenance of clinical efficacy after switching from originators to biosimilars; therefore, such a transition is increasingly encouraged both in the US and Europe mainly for economic reasons. However, despite the considerable saving, such shifts to biosimilar drugs are still being debated, principally over their ethical implications. Since the drugs are similar but not identical, the main issues are related to the possibility to compare the adverse events and/or the lack of efficacy and, to date, the variability in effectiveness for a single patient remains an unpredictable datum before effecting the switch. Despite encouraging data about the maintenance of efficacy and safety after the switch, there are many reports of discontinuation due both lack of efficacy or and adverse events. In this chapter we aim at showing the disease activity trend and the safety after the transition to TNF-i biosimilars in patients with rheumatic diseases in real life.
Part of the book: Biosimilars